Comparative evaluation of propofol, sevoflurane and desflurane for neuroanaesthesia: A prospective randomised study in patients undergoing elective supratentorial craniotomy

Abstract

Background and Aims:Both inhalational and intravenous anaesthetic agents are being used for neuroanaesthesia. Clinical trials comparing “propofol and sevoflurane” and “desflurane and sevoflurane” have been published. However, the comparison of all the three anaesthetics in neurosurgical patients has not been done. A randomised clinical study was carried out comparing propofol, sevoflurane and desflurane to find the ideal neuroanaesthetic agent.Methods:A total of 75 adult patients undergoing elective craniotomy for supratentorial tumours were included in the study. The patients were induced with morphine 0.1 mg/kg and thiopentone 4-6 mg/kg. Neuromuscular blockade was facilitated with vecuronium. The patients were randomised to receive propofol, sevoflurane or desflurane along with nitrous oxide in oxygen for maintenance of anaesthesia. The neuromuscular blockade was reversed following the surgery once the patients opened eyes or responded to verbal commands. The three anaesthetics were compared for their effects on haemodynamics, brain relaxation and emergence characteristics.Results:The mean arterial blood pressure during anaesthesia was comparable among the groups. The patients receiving sevoflurane had faster heart rates intraoperatively when compared to desflurane (P < 0.05). The brain relaxation scores at various intraoperative time frames were comparable among the three groups (P > 0.05). The time to response to verbal commands were significantly prolonged with use of sevoflurane (8.0 ± 2.9 min) when compared to propofol (5.3 ± 2.9 min) and desflurane (5.2 ± 2.6 min) (P = 0.003). However, the time to emergence and the number of patients who had early emergence (<15 min) were comparable among the groups (P > 0.05). The quality of emergence (coughing and emergence agitation), as well as postoperative complications, were also comparable among the three groups.Conclusions:All the three anaesthetic agents-propofol, sevoflurane and desflurane appear comparable and acceptable with regard to their clinical profile during anaesthesia in patients undergoing elective supratentorial surgeries.

Bi-frontal pneumocephalus is an independent risk factor for early postoperative agitation in adult patients admitted to intensive care unit after elective craniotomy for brain tumor: A prospective cohort study

“…The incidence of agitation in our group of patients (13%) was within the range reported in previous studies (3% to 22%) [ 1 , 3 , 5 – 7 , 17 – 20 ] but markedly lower than that identified in our previous study (29%) [ 4 ]. Several changes to clinical practice in our institution were implemented after the completion of our previous studies.…”

Comparison of postoperative cognitive dysfunction with the use of propofol versus desflurane in patients undergoing surgery for clipping of aneurysm after subarachnoid hemorrhage

“…in their study on supratentorial lesions found comparable hemodynamics with propofol, sevoflurane, and desflurane. [ 2 ] In our study, we also found that intraoperative hemodynamics with respect to HR was comparable in both groups except at dura closure, skin closure, and removal of headpins. Although the difference in results of HR was statistically significant, the difference was clinically not important.…”

“…where they compared propofol, sevoflurane, and desflurane as a choice of anesthetic agent in patients undergoing elective supratentorial craniotomy. [ 2 ] In their trial in which each group had 25 patients, they did not find any appreciable difference in the relaxation of the brain with the use of any of the three agents ( P = 0.70).…”

Effects of avoiding neuromuscular blocking agents during maintenance of anaesthesia on recovery characteristics in patients undergoing craniotomy for supratentorial lesions: A randomised controlled study

“…[ 15 ] Propofol, sevoflurane and desflurane have the same and acceptable effects on the brain relaxation scores at various stages of surgery. [ 16 ] Dexmedetomidine is not sufficient to suppress haemodynamic responses but decreases the requirement of inhalation agents and provides brain relaxation and good surgical field exposure conditions without any side effect in patients undergoing supratentorial craniotomy. [ 5 ]…”